Cai Jiawei, Fang Wenhua, Chen Fuxiang, Lin Zhangya, Lin Yuanxiang, Yu Lianghong, Yao Peisen, Kang Dezhi
Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China.
Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China; The First Clinical Medical College of Fujian Medical University, Fuzhou, Fujian 350005, China.
J Clin Neurosci. 2018 Aug;54:29-32. doi: 10.1016/j.jocn.2018.04.073. Epub 2018 May 16.
To seek a cerebral perfusion pressure (CPP) threshold that can reduce the occurrence of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH).
We analyzed the clinical data of patients with the diagnosis of aSAH and underwent CPP monitoring in our department from February 2014 to December 2015. CPP was divided into four specified thresholds by every 10 mmHg increments, which were from 50 mmHg to 80 mmHg. The totally time ratio of CPP below each threshold was calculated. The correlation between the time ratio and DCI were analyzed using binary logistic regression. And receiver operating characteristic curve was performed to identify the cutoff time ratios at higher risk of DCI.
Finally, 17 patients developed DCI from 60 patients who were recruited. The time ratios of CPP which was below 50 mmHg, 60 mmHg and 70 mmHg were found predictors of DCI by the binary logistic regression. The cutoff time ratios were 0.4% (AUC = 0.777), 7.0% (AUC = 0.702), 28.7% (AUC = 0.696) respectively. While at the level of 80 mmHg, the cutoff time ratio was 65% (AUC = 0.595). It was not related to DCI (P = 0.167). Patients suffered from DCI had a worse outcome than who did not at 3 month after aSAH (P = 0.018).
Time ratios at higher risk of DCI had a positive relationship with the CPP thresholds. Keeping CPP above 70 mmHg may be helpful to prevent DCI after aSAH, but it still needs further investigation.
寻找一个能降低动脉瘤性蛛网膜下腔出血（aSAH）后迟发性脑缺血（DCI）发生率的脑灌注压（CPP）阈值。
我们分析了2014年2月至2015年12月在我科诊断为aSAH并接受CPP监测的患者的临床资料。CPP以每10mmHg为增量分为四个特定阈值，范围为50mmHg至80mmHg。计算每个阈值以下CPP的总时间比。使用二元逻辑回归分析时间比与DCI之间的相关性。并绘制受试者工作特征曲线以确定DCI高风险的临界时间比。
最终，60例入选患者中有17例发生DCI。二元逻辑回归发现CPP低于50mmHg、60mmHg和70mmHg时的时间比是DCI的预测因素。临界时间比分别为0.4%（AUC = 0.777）、7.0%（AUC = 0.702）、28.7%（AUC = 0.696）。而在80mmHg水平时，临界时间比为65%（AUC = 0.595）。它与DCI无关（P = 0.167）。aSAH后3个月时，发生DCI的患者预后比未发生DCI的患者差（P = 0.018）。
DCI高风险的时间比与CPP阈值呈正相关。将CPP维持在70mmHg以上可能有助于预防aSAH后的DCI，但仍需进一步研究。
